Pediatric Care Manager (RN) - Hybrid in Pinellas County, FL

Molina Healthcare, Inc.; Clearwater (FL); On-site; USD 36,000 - 71,000; Full time

Job summary

Molina Healthcare, Inc. seeks a qualified Care Manager RN to support care coordination and ensure optimal member outcomes across the continuum. Responsibilities include assessments, planning, and collaborating with the care team, while traveling as required.

The role emphasizes effective communication, documentation, and proactive member engagement to improve quality and cost-effectiveness of care in diverse settings.

Qualifications

• Requires at least 2 years of experience in health care, care management or related field.
• Active RN license in the practicing state.
• Valid driver's license and ability to travel 25–40% as required.
• Familiarity with EMR and HIPAA regulations.
• Ability to work across settings with diverse populations.

Responsibilities

• Complete member assessments within regulatory timelines and identify care management eligibility.
• Develop and implement interdisciplinary care coordination plans with the member and care team.
• Conduct telephonic, in-person, or home visits as needed.
• Monitor care plan effectiveness and document progress toward goals.
• Maintain an ongoing member caseload with proactive outreach.

Skills

Care coordination

RN

Communication

Time management

Problem solving

Critical thinking

EMR navigation

Education

Registered Nurse (RN) license

Tools

EMR software

HIPAA knowledge

Job description

JOB DESCRIPTION Job Summary

Provides support for care management/care coordination activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care.

Essential Job Duties

• Completes comprehensive assessments of members per regulated timelines and determines who may qualify for care management based on clinical judgment, changes in member health or psychosocial wellness and triggers identified in assessments.
• Develops and implements care coordination plan in collaboration with member, caregiver, physician and/or other appropriate health care professionals and member support network to address member needs and goals.
• Conducts telephonic, face-to-face or home visits as required.
• Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.
• Maintains ongoing member caseload for regular outreach and management.
• Promotes integration of services for members including behavioral health, long-term services and supports (LTSS), and home and community resources to enhance continuity of care.
• Facilitates interdisciplinary care team (ICT) meetings and informal ICT collaboration.
• Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts.
• Assess for barriers to care, provides care coordination and assistance to member to address concerns.
• May provide consultation, resources and recommendations to peers as needed.
• Care manager RNs may be assigned complex member cases and medication regimens.
• Care manager RNs may conduct medication reconciliation as needed.
• 25-40% estimated local travel may be required (based upon state/contractual requirements).

Required Qualifications

• At least 2 years experience in health care, preferably in care management, or experience in a medical and/or behavioral health setting, or equivalent combination of relevant education and experience.
• Registered Nurse (RN). License must be active and unrestricted in state of practice.
• Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law.
• Understanding of the electronic medical record (EMR) and Health Insurance Portability and Accountability Act (HIPAA).
• Demonstrated knowledge of community resources.
• Ability to operate proactively and demonstrate detail-oriented work.
• Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations.
• Ability to work independently, with minimal supervision and self‑motivation.
• Responsiveness in all forms of communication, and ability to remain calm in high‑pressure situations.
• Ability to develop and maintain professional relationships.
• Excellent time‑management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.
• Excellent problem‑solving, and critical‑thinking skills.
• Strong verbal and written communication skills.
• Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases.

Preferred Qualifications

• Certified Case Manager (CCM).

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $26.41 - $51.49 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.